Exercise and Arthritis
There are more than 100 rheumatologic diseases, of which the most common are osteoarthritis (a degenerative disease) and rheumatoid arthritis (an inflammatory, multi-joint, multi-system disease).
In osteoarthritis (OA) the cartilage that covers and cushions the ends of the knee degenerates, allowing the bone surfaces to rub together. The major symptom of OA is pain (inflammation is usually only a problem late in the course of the disease). Commonly affected joints are the knees, hips, back, neck, and hands. In OA there is local degeneration. In other words it is not uncommon for affected joints to be on one side of the body and not the other.
Rheumatoid arthritis (RA) is an autoimmune disease, in which the body's own agents attack the tissues of the joints, often making them feel 'hot' and swollen. Commonly affected joints include the wrists, hands, ankles, feet, and neck. The pain tends to be symmetrical on both sides of the body.
Benefits of Exercise
Exercise is beneficial for almost everyone with arthritis, regardless of which type. Cartilage has no blood supply of its own. The motion of exercise nourishes the joints with synovial fluid by squeezing it in and out of the joint space, delivering nutrients to the cartilage and removing waste products. In addition the many problems associated with arthritis, such as poor posture and awkward gait, are exacerbated by inactivity. Exercise is the key to better body mechanics, the chief benefits being: improved strength and flexibility of affected joints, improved balance and co-ordination, and pain relief.
Although people with RA initially tend to experience fatigue that limits their stamina, they can increase their stamina through exercise. Other general health improvements occurring with participation in a regular exercise programme include: lowered blood pressure and cholesterol levels, increased energy, enhanced sleep and relaxation, decreased stress, decreased body fat, helping diabetics to gain greater control over their blood-sugar levels, and increased bone density, (thereby possibly retarding or preventing the development of arthritis).
Best Time of Day to Exercise
People with RA often find that their pain tends to be worse in the mornings, and so prefer to exercise in the afternoons. In contrast, people with OA tend to feel best in the morning, and then notice an increase in pain as the day progresses. Ideally, you should exercise at whatever time works best for you. If work or lifestyle commitments make this impractical, you should try to set aside 15 minutes to relax before exercise.
If you take pain medications, try not to exercise when the medication is at its peak effectiveness. You may be masking important pain messages that would otherwise prevent you from performing an exercise or activity that is too strenuous for your ability.
Exercising during Flare Ups
Exercise does not in itself cause flare ups. Arthritis is erratic in nature, and most sufferers find that symptoms can come in cycles or 'flare up' for no apparent reason. You need to concentrate on modifying your exercise routine rather than stopping it altogether. In most cases it is the aerobic part which has to be suspended. Gentle stretching can still be performed. In fact extra stretching instead of the aerobic activity may provide relief, although you should take care with inflamed joints. If you have to take a few days off your regular exercise programme then so be it. However you should also take a few days to gradually build up to your previous level of fitness.
- Make a realistic personal commitment to exercise regularly. (Irregular exercise sessions are more likely to cause injury and increased pain).
- Stretch daily.
- Listen to your body and respect its limitations.
- Gradually build up the difficulty of your exercise programme at your own pace. Reduce your level of exercise if pain increases.
- Consult your doctor if pain persists.
- Try different activities - you may be pleasantly surprised!
- Any exercise causing severe pain or discomfort.
- Exercising a 'hot', swollen, or inflamed joint.
- Activities that cause joint pain lasting more than 1-2 hours after exercise.
- High impact activities or overstretching.
- Stairclimbing, jogging, or running if the hip or knee joints are affected.
- Taking medication to mask exercise-induced pain/stiffness. (It will go away as you become accustomed to your new level of activity. In the meantime, reduce the intensity of the activity a little and concentrate on building up your fitness gradually.
Aerobic Exercise Guidelines
Suitable activities include brisk walking, cycling, swimming, low impact aerobics or dance classes. (Tai chi is also an excellent 'all-rounder', although not as aerobic as those listed above). The more advanced may consider light jogging or running on approval from their doctor.
Exercise from as little as 5 minutes to begin with if you are new to exercise, gradually build up adding another 5 minutes when ready until you can do 30 minutes of continuous aerobic activity. Always begin the activity with a warm up and always finish with a cool down. Progression of duration is more important than simply increasing the intensity. The right intensity can be determined using the 'talk-sing' method. That is, you can hold a conversation without stopping the activity but cannot sing without becoming too out of breath (and having to stop the activity). Aim to be exercising like this 3-5 times a week.
Daily Stretch Suggestions
If you are uncertain about any aspect of these exercises or are new to exercise you should consult your physician before participation in this or any other exercise programme. Be sure to ask about any special restrictions that may apply to new or existing artificial joints.
The following stretches have been chosen as they can be performed either sitting or standing, and just about anywhere you may happen to be. Take extra time and caution when stretching affected areas.
- a) Keeping your head level and chest/shoulders facing front, slowly turn your head to the right as though trying to see behind your back. Hold briefly.
- b) Return your head and eyes to the centre.
- c) Repeat, turning to the left. Hold briefly.
- d) Return to the starting position.
Ear to Shoulder
- a) Keeping your head level and chest/shoulders facing front, slowly drop your right ear down towards your right shoulder.
- b) At the same time slide your left arm downwards as if you were trying to reach your knee. Do not bend forwards whilst doing this. Hold briefly.
- c) Return to the starting position and repeat on the left side.
- a) Keep both your arms straight and down by your sides.
- b) Lift the arms straight out to the sides up to shoulder height. Hold briefly.
- c) From this position, bring both arms together until the palms of your hands touch in front of your body. Hold briefly.
- d) Move your hands back to position b).
- e) Without arching the low back, try to bring both arms together until the palms of your hands touch behind your body. Hold briefly.
- f) Move your hands back to position b).
- g) Move both arms straight up, until your palms touch, this time above your head. Hold briefly.
- h) Return to starting position a).
Wrist: Wrist Assist
- a) Using your left hand to help the right, gently bend your right wrist so that your right hand drops forward. Hold briefly.
- b) Bend your right wrist the opposite way, so that your left hand is raised. Hold briefly.
- c) Repeat the movements to stretch the left wrist.
- a) Keep the flat of your palm in a straight line with the forearm, level with the elbow.
- b) Without moving any other joint, try to move the right wrist so that the thumb moves towards the inside of the elbow joint. Hold briefly.
- c) Return to position a).
- d) Without moving any other joint, try to move the right wrist so that the little finger moves towards the outside of the elbow joint. Hold briefly.
- e) Return to position a) and repeat to stretch the left wrist.
- a) Rest your forearm and hand with your palm down on a flat surface.
- b) Twist your right wrist so that your palm is turned towards the ceiling. Hold briefly.
- c) Return to position a) and repeat to stretch the left wrist.
Hand/Fingers: Typists Warm up
- a) Make fists of both hands. Hold briefly.
- b) Relax your hands.
- c) Splay your fingers in each hand as wide as you can. Hold briefly.
- d) Relax your hands.
- e) Wiggle your fingers up and down and around randomly.
- f) Circle your wrists.
- g) Rub your hands together as if you were rubbing lotion on them.
Ankles/Feet: Ankle Twist
- a) Rotate your ankles so that your feet point in towards each other. Hold briefly, relax.
- b) Rotate your ankles in the opposite direction, pointing your feet outwards. Hold briefly, relax. Ankle Warm up a) Make fists of both feet by curling up your toes. Hold briefly. b) Relax your toes.
- c) Splay your toes in each foot as wide as you can.Hold briefly.
- d) Relax your toes.
- e) Wiggle your toes.
- f) Circle your ankles.
- g) Rub your feet together as if you were rubbing lotion on them.
Low Back: Pelvic Tilts
- a) Lie on back, knees bent, stomach in.
- b) Contract the gluteal muscles (not low back) and the abdominals, raising the pelvis off the ground without the aid of the back or legs. The low back should remain in contact with the floor at all times. Hold briefly, relax.
Knee to Chest
- a) Lie on back, knees bent, feet flat on floor.
- b) Lift your right knee towards your chest, gently pulling it closer with the aid of your hands.
- c) Hold briefly, breathing out at the same time.
- d) Return to position a) and repeat with the left leg.
- e) Return to position a) and repeat with both legs.
NB: Each stretch should be held 30 seconds as a minimum. The phrase 'hold briefly' is used as a beginners guide, where each stretch can be held for as little as 15 seconds. However, to gain any real benefit you should aim to stretch for a minimum of 30 seconds.
- Exercise In Menopause
The word menopause comes from the Greek meno meaning 'month' and pausis meaning 'ending'; literally, 'a pause in a lifecycle'. It is first thought to have been used by a French physician called Gardanne, who referred to it in 1812 as 'menepausie' and